Comment by DanBC | Hacker News Reader

Comment by DanBC | Hacker News Reader

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I didn't downvote you.

> Go for CBT and you'll find it largely amounts to filling out forms on your mental state with tickboxes that don't really apply to you, while somebody tries to find out ways that your thinking is twisted.

This is a poor version of CBT. Any practitioner providing CBT like this is doing it wrong.

CBT is not about telling you that you are wrong or that your thinking is twisted. CBT is about exploring with you what your thinking is; what's happening to you with those thoughts; how strongly you feel those thoughts and emotions. CBT is about helping you understand why you feel the things that you feel, and why you think the things you think.

There can be a bit of writing when you begin - some people find it useful to have the process down in a concrete form. There doesn't have to be writing. And checking boxes is not a good approach.

Medication works for some people. But the serotonin hypothesis is controversial.

> Do you want to medicate the hell out of the high-functioning, positive guy that wants to change the world

(I didn't view the YouTube)

Medication can have side effects, and sometimes they're not very nice. But most SSRIs don't have the kind of effects that people would describe as "medicate the hell out of".

Unfortunately, as it is practiced, this IS what CBT ends up being a good deal of the time. CBT has an implicit, and sometimes explicit, mechanistic view of human nature. This can come off as extremely judgmental to vulnerable and intelligent clients. Other approaches, like Motivational Interviewing, adopt a neutral stance that offers the potential for clients to actually explore their feelings instead of just getting rid of them.

http://en.wikipedia.org/wiki/Motivational_interviewing

Edit: re-reading my comment, I think I am coming off too hard on CBT. There are real reasons why clients can come out of CBT thinking the therapist is trying to find what is twisted with them or having them fill out pointless booklets - this does not completely undercut what CBT is about. There is good working going on to combine CBT with Motivational Interviewing to improve treatment of depression and suicidality.

http://www.selfdeterminationtheory.org/SDT/documents/2011_Br...

i am doing CBT (not often though, busy travelling work schedule). I suffer from bipolar I, and while the medication was the one thing that just completely changed my life, CBT is there to help me to:

- figure out my mood. this is about keeping checklists on how long i sleep, how i feel, if i took my medication, if i ate correctly. this sounds terribly stupid, but it is very hard for me to even understand what i am feeling. seeing a little graph that tells me "you have been sleeping 16 hours a day for the last 2 weeks, and now you are barely able to sleep for 3 hours, something is going on" is very helpful.

- figure out what i need to do when certain patterns have been recognized. this is for example upping up on sports, being careful about diet, going out to see people when i'm in the down phase. and conversely cutting down on sports, going out, meditation (which makes me way too energetic and stimulated), stimulants when being too far up.

- figuring out my own personal triggers and signs for depression. this is starting to come along, and these are kind of "personal" things. if i want a new tatoo, or learn a new skill or programming language, i should be careful because this is what usually accompanies mania.

it also involves meeting with other people with the same illness, and just for a few hours every year feeling that you are not the only one in that mess.

an interesting thing about the mood graphs is suddenly realizing that a lot of these mood swings actually come out of the blue, or are more related to seasonal effects. it is my brain tricking me into finding causes and patterns and reasons. i don't want to commit suicide because nobody loves me, it's more i think nobody loves me because i am depressed because i haven't gone out for 2 weeks and missed out on my medication 3 days in a row. or because it is december.

i find CBT (at least with the practictioner i have) to be a very no-bullshit pragmatic approach to handling the psychological side of the illness.

but seriously (and in a way, thank god i have bipolar), medication works extremely well, and the one i take (lamictal) has almost no side effect.

CBT seems to be based on the idea that "wrong thought" breeds negative emotions. For example "I always screw up" should be replaced with "I screwed up this time". But if something like "I screw up on X most of the time" or "I am in the bottom percentile for X" are statements that may occur to an analytical person that are objectively true and may directly cause negative emotions. My understanding of CBT is that it suggests replacing these thoughts with positive forms like "sometimes I succeed at X" and "I'm better than most people at Y" (even if Y is something neither you nor anyone else cares about).

So CBT is fine if your thoughts do not reflect reality but if they seem to encourage self-delusion. And maybe that's fine, after all what else is there than perception. But many intelligent analytical people simply cannot willfully deceive themselves.

No. This is a misunderstanding of what CBT is about.

> But if something like "I screw up on X most of the time" or "I am in the bottom percentile for X" are statements that may occur to an analytical person that are objectively true and may directly cause negative emotions.

Okay.

> My understanding of CBT is that it suggests replacing these thoughts with positive forms like "sometimes I succeed at X" and "I'm better than most people at Y" (even if Y is something neither you nor anyone else cares about).

No.

Someone says "I screw up on X most of the time".

This is objectively true, and causes negative emotion.

Start with "What emotion do you feel?" Perhaps it's something like "shame" or "regret".

The therapist explores with you what your body is doing. When a person feels anxious their heart rate increases. Here's an important bit: try asking someone to slow down their heart rate - they can't. And it's the same if you ask someone to change a thought - they can't. The therapist will explain to you different physiological changes (sweating, breathing, heart rate, tense muscles, etc.) As you become aware of these things you can try breathing exercises to help ease tension.

Then ask what the hot thought is; what is the thought connected to "I screw up on X most of the time" that creates the feelings of shame? Perhaps the hot thought is "Other people get this, it should be really easy, I keep getting it wrong" or "I keep getting this wrong, and my team members have to keep correcting it for me, and it causes them more work and stress and tension".

You assign strengths to the emotions and to the hot thoughts.

You sit with them for a while - you're not trying to change anything yet.

And then, "I screw up on X most of the time"; well, can X be passed on to someone else who doesn't screw it up? Can someone give you extra help with X, or can they spend some time to teach you X? Notice that none of these are denying the reality of X. But now rather than worrying about stuff you can't change, you're giving yourself time to think about things you can change.

> So CBT is fine if your thoughts do not reflect reality but if they seem to encourage self-delusion.

I really fucking hate it when people condemn an evidence based effective cheap therapy based on misunderstanding and ignorance. Your attitude is causing harm to people who would benefit from CBT but who don't try it.

My understanding of CBT comes primarily from Burn's "Feeling Good", the exemplar for CBT therapy.

The quotes below are taken from the book and are consistent with my previous description of CBT.

"change the way you feel by changing the way you think".

"... we think that the causes [of our bad moods] result from something beyond our control... you can learn to change the way you think about things, and you can also change your values and beliefs. And when you do, you will often experience profound and lasting changes in your mood, outlook, and productivity. That in a nutshell is what cognitive therapy is all about."

Emphasis mine.

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